depression

I went to a conference in Nottingham yesterday to learn about a technique called Open Dialogue. I wanted to know more because of how it has revolutionised the care of people who are in crisis in parts of Finland and the US, reducing demand on mental hospitals and transforming lives.

I care deeply about mental health services, although I don’t run them any more. These days I campaign to make them better. I volunteer in suicide prevention. I chair the Time to Change mental health professionals project. And sometimes I need help from services myself.

I wish you could have been there too. Some massive pennies dropped, not just for me but for everyone who hadn’t already appreciated the possibilities. We learned that Open Dialogue is about being with people rather than doing something to them. And we realised that here was a way to mend things that previously seemed unfixable.

Let me explain.

There are some who say that the NHS is broken. And that mental health services are badly broken.

I’m not sure that broken is a helpful way to describe things. I prefer to think of them as badly wounded. And when someone is wounded, you take care of them.

I believe that people in highly influential positions do care about mental health. They are just unsure about what to to do, other than saying they care. They know that mental health services around the country are buckling under the strain of increasing demand. Referral rates have never been higher. And continue to climb. Services find it increasingly difficult to discharge people because there is nowhere for them to go. Staff are overwhelmed, and there is a growing recruitment and morale crisis.

Added to which, successive governments say one thing about the importance of mental health but allow the opposite to happen regarding funding. Despite the fine words and promises in the response to the Mental Health Taskforce report published in February, we heard just a few weeks ago from NHS Providers that mental health trusts are not seeing the promised investment and some are reporting funding cuts in 2016 – 2017. Parity of esteem? Actions speak louder than words.

How might Open Dialogue help?

Firstly, it isn’t simply a technique for listening really carefully to people who experience trauma and distress AND their families so that together they can work out their own solutions, with support. It is also an extremely respectful way for people to relate to one another, in teams, across teams, organisations, health care systems and society. Even the NHS.

Secondly, Open Dialogue is the antidote to what is sometimes called the biomedical model, when doctor knows best and patients are compliant. This works when there is a fairly simple problem and solution. For example, a broken leg. It doesn’t work for the vast majority of health conditions in which people need to become the expert themselves if they are to lead fulfilling lives. And it certainly doesn’t work in mental health. Mental health professionals know this. But we organise and regulate mental health services as though we were fixing broken minds instead of legs.

Open Dialogue builds on what some call the Recovery Model, based on hope and fulfilment rather than simply diagnosis and treatment. It provides a method to apply a recovery-based approach, involving the whole family and team. It is the antidote to outpatient clinics and ward rounds.

Thirdly, Open Dialogue provides the basis from which to challenge many of the perverse incentives and restrictive practices that have grown up in mental health care out of fear of incident, media criticism or what a regulator might say. Such as staff spending more time documenting care than in giving care. The absolute adherence to risk assessment even though successive independent investigations show it to have limited predictive value. And risk management, which taken to extremes means that those who might possibly pose a risk to themselves or others, are cared for in inhumane conditions with no privacy or dignity, no sheets, cutlery, shoelaces, phone chargers or indeed any other item that someone somewhere has said might pose a risk. And yet we know that ligatures and weapons can be fashioned from almost anything. And that people who are ill, frightened and alone can be driven to do increasingly desperate things. The greatest risk management tool available is compassionate, skilled attention. Open Dialogue offers high quantities of that.

Open Dialogue is being used in a growing number of services in the UK. A research bid has been submitted and passed the first round of scrutiny. If successful, it will explore human, clinical and cost effectiveness, as well as developing a model that is scalable and sensitive to local circumstances.

And to Corrine Hendy, who I first met at an NHS England event about putting patients first last year: Your journey from being locked in a mental hospital to becoming a skilled mental health professional, public speaker and highly effective advocate for Open Dialogue, is more inspirational than any you will hear on X-Factor. I want to repay the inspiration you have selflessly given.

This week has been Mental Health Awareness Week. I’ve written three articles, visited a friend, given a talk, attended a party and been on a bike ride.

There’s been some other more difficult stuff which I don’t feel able to write about just now. More anon.

I wrote this piece about the loss of Sally Brampton through depression and what is assumed to have been suicide.

Suicide casts a long, cold shadow. My heart goes out to all who have lost someone that way. And to all who have tried to keep them safe. There is sometimes talk of failure in such circumstances. I fully understand why. But it can be cruel and destructive to those left behind. It can affect the grieving process and have terrible repercussions. I decided a while ago to devote some of my time to being a volunteer in suicide prevention. This work can of course be distressing. But is so worthwhile. If more people were involved in understanding about suicide, it would improve compassion and more lives might be saved. Blame doesn’t save anyone. If anything, it can have the opposite effect.

On Monday I popped up to Rugby to see the lovely Gill Phillips and learn more about the groundbreaking work she does through her company @WhoseShoes. Gill had a special birthday this week – now she’s nearly as old as me! I love the way that this entrepreneurial woman has started a new adventure. I hope I can support Gill to bring Whose Shoes to the world of mental health. Go us!

Just Giving asked me to write this list of ideas to help people to manage their own mental health. It’s been fun watching the list grow throughout the week, and hearing comments from unlikely places about the tips. I just curated the list – none of them were invented by me. I try to follow them, not always successfully.

And I wrote this piece called Serendipity for NHS Employers. It was also Equality and Human Rights week. It was serendipitous to bring two things together that matter very much to me but which I hadn’t realised before had so much in common. I’ve had some useful feedback. It has sparked conversations about how we can use Mary Seacole’s legacy to inspire young people not just to dream, but to work hard and not be deterred by setbacks from achieving their ambitions.

One of my ambitions is to see the top of the NHS become less white and less male. Nothing against you guys, but as it says in my blog, the way things are now just isn’t representative. And having an unrepresentative leadership breeds alienation and resentment which has a negative impact on services.

On Thursday afternoon I spoke at a Brighton Housing Trust Health and Wellbeing Service event (photo above). I was invited there to inspire the women with my experiences of being a high profile woman who is also open about my own mental illness. But to be honest, it was they who inspired me. I heard some stories I will never forget. I want everyone to know what we agreed, which is that people who live with mental illness have assets to share. Rather than deficits to avoid or accommodate. I’m going to be returning to this theme in the future.

I was at the beautiful Black Cultural Archive in Brixton on Thursday evening at a comedy night with a purpose – to thank all the ambassadors and trustees who have spent 12 long years raising money for the Mary Seacole Statue. That’s me with our brilliant and indefatigable Vice Chair Professor Elizabeth Anionwu CBE. Mary’s statue goes up in six weeks – much more about this soon.

And on Friday I was out cycle training with my friend Sally who is joining me on Ride 100 on 31st July when we will be raising money for Samaritans. You’ll be hearing a lot more about that shortly. Suffice to say, after doing 20 miles of hills, including the notorious Box Hill (twice) we felt pretty smug 🙂

I was saddened to hear of Sally Brampton’s untimely death after a long battle with depression. She was 60, the same age as me. From my own experiences of depression, I know a little of how things must have been for her. My heart goes out to all who loved her. May she rest in peace.

Next week is Mental Health Awareness Week.

For those who are struggling, I say this. Mental illnesses mess with your head. They make you believe bad things about yourself. That there is nothing wrong with you other than laziness, moral cowardice, being hateful and lacking what it takes to lead a normal life. That you are not worthy of help. And that you must face this awful, isolating thing alone.

But struggling on alone is not a good idea. Nor is pretending to be OK when you are not. I know this from my own past, effective but wrong-headed attempts to keep how I was feeling to myself. In the end, keeping secrets just causes more damage. It can be really bad for you and those you care about.

If you are overwhelmed by negative or frightening thoughts, if life feels grim or even just pointless, please, please ask for help.

Talk to a friend or someone else that you trust.

Make an appointment to see your GP.

Check out the Grassroots Suicide Prevention StayAlive app – available free to download to iPhones and Androids.

Phone Samaritans on 116 123 or one of the other helplines.

If you don’t know what to say at first, or feel embarrassed or tongue-tied, it doesn’t matter. If you are afraid that the words won’t come, try writing it down.

Social media has been a massive help to me. I have made friends online who always seem to be there. They have been to those evil places. Not the same as mine, because we are all different, but their own terrifying versions. They know how lonely it feels.

Contrary to what you may hear, there are wonderful services available and treatments – medicines, many different sorts of therapy and other practical techniques – that work for most people. It can take time to find the right ones, of course. And it will take a lot of courage and effort on your part. There are no miracle cures. But I promise you, seeking help really is worth it.

I took part in a Twitter chat recently on the above topic. Thanks to @AnthonyLongbone for encouraging me to join in. Below are some thoughts I shared in advance.

What does mental health mean to me?

Mental health is the most important part of health. And it is integral to physical health. You can’t look after your body if your mind is in a poorly way.

Mental health is a continuum with optimal wellbeing at one end of the spectrum and mental illness at the other. Some people seem to be able to take good mental health for granted. For others, maintaining our mental health requires almost constant vigilance and care.

Facing up to my tendency to depression has been the most important self-help step I have taken in my life so far. I’m hopeful I won’t ever sink as low as I did in 2013. But I’m not making any assumptions. And I do not plan to judge myself negatively if I do experience another bout either.

Judging myself – or indeed others who experience mental illness – is the least helpful thing any of us can do. Who knows why I or anyone else has this tendency? What does matter is what I do from now on to help myself and allow others to help me. Which includes understanding my own triggers and warning signs.

All serious illnesses require some degree of courage, so that we can face the pain and the treatment required to help us get better. But mental illnesses can be harder to bear than physical illnesses . They mess with your head. They make you believe bad things about yourself and others. They take away your hope and they affect your judgement and even your personality. They make you isolated and afraid. Some people hear the voices of others telling them bad things. In my case, I only hear my own voice. When I am poorly, my internal voice is harsh, judgemental and cruel. It tells me I am worthless and evil. I am still learning how to notice that voice when it starts whispering to me, and how to answer it.

Since I decided to be more open about my own experiences, I have made some extraordinary friends. Our mutual support during rocky moments via social media undoubtedly saves and enhances lives. I love the equality and the loving kindness of these relationships. We all have something to bring.

It’s because of all this that I know how amazing other people who experience mental illness are. How courageous, funny, honest, thoughtful and kind – hearted. And this is how I know, beyond all reasonable doubt, that people who have had such experiences have assets that should be applauded and sought by others. Rather than deficits to be pitied or avoided.

…………………………………………………………

After the chat, I felt a bit overwhelmed. The people who joined in were just amazing. Brave, honest, intelligent, thoughtful, generous and kind. I am in awe of them. They have far more of merit to say than I do.

In conclusion, what mental health means to me is being part of a group of wonderful people like the ones I was talking with tonight. They are helping me to become the best version of myself, which includes being kinder to myself. Through this, I can become kinder to others and do my tiny bit to help them too.

It was nice that 12,500 people read my two recent blogs on the mental health angle of a current The Archers storyline.

But it wasn’t all good. I am a sucker for positive reinforcement, including WordPress stats. And I doubt I will ever again get 4,500 views in a single day.

And that’s the thing about maintaining one’s mental well-being if you are one of the 1:4 people like me for whom it is sometimes a struggle. I’ve been a bit down since those two blogs. I’ve questioned whether I’ve got anything interesting left to say. And yet I know I need to write about stuff to work out what I think.

Here’s what I’m thinking about today.

Someone said to me recently, with real sincerity, that the tide is turning on the stigma of mental illness. They said they thought that the battle had been won because people like me can stand up and say that we sometimes need help from mental health services. And not be judged.

But I thought hmm.

Because it doesn’t feel that way. Not to me, nor the friends I’ve made through social media and in real life. Especially not those who haven’t been as fortunate as me and are forced to grind out an existence on state benefits juggled with occasional paid work. The positives from such work are overshadowed by arcane, dis-empowering rules of which it is almost impossible not to fall foul. Nor does it feel that way to those who live in fear of losing their homes, or who haven’t even got a place to call home. Current government policy feels deeply discriminatory and the exact opposite of therapeutic for those already experiencing the potentially crippling challenges of mental illness.

It doesn’t feel that the stigma has gone away for the people who can’t get the right mental health treatment, or even any treatment at all. As a wise person recently said, imagine telling the parents of a child with early stage cancer that they have to wait until things seriously deteriorate before they can see a specialist. And even then, the care will be rationed and probably not what is recommended. That’s the reality in many parts of the UK, for children and adults too.

I heard a senior commissioner say the other day that they would love to invest more in mental health, but the evidence just isn’t strong enough (my italics). What planet are they living on?? True, spending on mental health research is woeful. But there is nonetheless masses of really good evidence about what works. And it starts with intervening early via properly funded local services delivered by highly trained, well-supported staff.

What also doesn’t help reduce stigma is the almost constant service redesign and reconfiguration. Indeed, the billion pounds of “new” money announced by Jeremy Hunt after the Mental Health Taskforce Report was published is not, in fact, new at all. It has to be achieved through efficiency savings. I know from experience that such initiatives rarely achieve all that is promised. And they almost never take account of the collateral damage to staff well-being.

Not to mention competitive tendering, which mental health services face at disproportionately greater levels than other parts of the NHS. Plus the drip-drip reduction in mental health funding and the erosion of national data collection so that it takes the skills of investigative journalists to uncover the ongoing cuts that have been made over the past 6 years despite government rhetoric about parity of esteem for mental health.

And what adds further to the stigma is that the media rarely mention mental illness or mental health services except when something appears to have gone wrong. Where are the motivational stories like the ones about people who have “beaten” cancer? Even when no mistakes have been made, the finger of blame gets pointed. Imagine how this feels to staff who work in these services, being pilloried for doing a job that most people couldn’t begin to contemplate because they don’t have the skills, patience, courage and compassion needed to work in mental health. They should be lauded and supported, not ignored and criticised.

So no, the stigma of mental illness is not a thing of the past. It is ugly, cruel, destructive and ever-present. Like racism, sexism and homophobia, it will never truly go away. We have to be vigilant. And we have to keep working at it.

Despite the job I once did, it took me until I was 58 to get over my own self stigma and admit that I experienced clinical depression from time to time. Coming out about it was the hardest but also one of the best decisions I ever made. I take my hat off to others who have got to that point sooner than me. You are braver than anyone who hasn’t been there will ever know. Showing the world that people who experience mental illness have hopes and ideas and other wonderful human assets to share is the best way there is to make others want to join us and change the way things are.

Writing about mental health and The Archers was fun. Writing this piece was harder but far more satisfying. I will try not to care how many people read it.

I love talking about mental health. What could matter more? This blog is drawn from ideas I have developed (and squirreled) while thinking about well-being at work for a slot I did at the Health at Work Conference in Birmingham last week, and in advance of an NHS Employers webinar on staff well-being yesterday. I used an earlier version of this blog to give my talk, and I warmly thank everyone who contributed. Your questions and comments were wonderful and you will be able to see that i have made some changes because of them.

And what an exciting day yesterday was. Because the Girl Guides Association announced their first mental health badge. It has been developed with the excellent charity Young Minds. It uses theories about emotional literacy and resilience to help young people take care of themselves and help others. If only they had done this 48 years ago was I was a Girl Guide. And wouldn’t it be great if such an approach could be rolled out across all schools and colleges and youth groups? What a brilliant start this would give young people facing the world.

At the conference last week, we heard from companies large and small who are putting employee wellbeing front and centre of their investment strategies. And this isn’t because of any sense of duty or even kindness. They know that it pays. They want to know the best ways to help staff achieve optimum health and how best to work with employees who have physical or mental illnesses to manage their conditions and get back to work quickly and well.

If we consider the NHS as one employer, it is the largest in Europe, many times bigger than even the largest multinationals at that conference. And yet we seem slow to follow suit. I say we…I don’t work for the NHS any more. But having done so over a period of 41 years, I feel deeply concerned for its staff. So I was very grateful to take part in the NHS Employers webinar.

Well-being and resilience are the new buzzwords. They are being used everywhere. I like them. But I also have a few issues with them. If we aren’t careful, well-being strategies can feel as if they place responsibility on the individual. And I see well-being as a partnership between the individual, their employer, their co-workers and anyone else they choose to invite to help them achieve their optimum health.

I like the Maudsley Learning model of mental health very much. It shows a series of steps and explains that we are all on a spectrum of mental wellness. I like the way it removes a sense of us and them.

But there are nonetheless inherent dangers in such models. Unless you have felt the terrifying symptoms of psychosis, clinical depression, an eating disorder or any of the other hundreds of mental illnesses, you might think that mental ill-health is merely an extreme version of the distress that anyone might feel when something bad happens. Using well-intentioned euphemisms like mental distress, intended to reduce stigma, can add to the isolation felt by people who experience mental illness. It’s important to say that most people won’t ever experience mental illness, just as most people won’t ever experience cancer or diabetes.

But 1:4 of us will. And we need skilled help from our employers if we are to go back to work at the right time and give of our best. The last time I was ill, I was lucky that I got the right help. Not everyone does. And that is why I do the work I do now, campaigning to improve things in the NHS and beyond for patients and staff.

I shared two specific insights at NHS Employers webinar. The first is that we separate mental and physical health for laudable reasons but at our peril. Obesity might get more sympathy if it were treated as an eating disorder; the most effective treatments combine diet with psychological support, including CBT techniques. Exercise is known to increase endorphins and improve mental wellbeing as well as physical health. People with serious mental illnesses die on average at least 20 years too soon, mainly because of associated poor physical health. And there is an increasing evidence base that people with chronic physical conditions such as cancer, heart disease and strokes have a greater tendency to experience clinical depression. Which comes first doesn’t really matter.

Employers should, in my view, use this knowledge of the inherent links between mind and body to devise their wellbeing strategies and make this explicit. Bringing the mind and the body back together needs to become the next Big Thing.

And secondly, I am increasingly of the view that people who experience mental illness, who are open about it and learn to live well with it despite the massive challenges it poses, can become even better employees than those who don’t have these experiences. I’m talking about people like many of the friends I have met since I came out about my own depression. Such people show extraordinary resilience, compassion for themselves and others, patience, creativity and highly developed social skills that would be valuable in any workplace. They are truly amazing. I try not to have regrets. But one of mine is that it took me far too long to realise that my experience of mental illness could become an asset, if I let it. So now I’m trying to make up for lost time!

I want to share links to my other blogs that I think might be helpful to anyone thinking about wellbeing at work.

And this is my Letter to You. Which you might want to suggest to someone who you think may be struggling.

Life is hard for most employees these days. Working in the NHS holds particular challenges. Stress at work doesn’t have to make people ill. But it can. Employers can make a difference. And so can co-workers.

Please take a moment to think about your colleagues, especially the ones who are having a tough time, seem a bit quieter than usual or not quite their usual selves. Ask them how they are. And really listen carefully to what they reply.

And if you are one of the 1:4 of us who experience mental illness from time to time, I say this: go us. Because we rock. 😎😎😎

Last night, some of us were tweeting about The Archers. Specifically, about the scumbag Rob Titchenor whose latest act of psychological warfare against his wife Helen was to hit her and then make her feel so bad that, by the end of the 13 minute programme, she had apologised for making him do it. He then delivered his coup de grace, that she was in need of psychiatric help.

As you can imagine, this generated much debate. Quite a few people said that it wasn’t Helen that needed a psychiatrist, it was Rob. They said he was sick. I believe they are wrong. And I want to explain why I think this.

Is Helen mentally ill? And if she is, could Rob have caused it?

Only someone who is clinically qualified can really answer this question. But as Helen is a fictional character and therefore unavailable for an assessment and formulation, we are entitled to make assumptions.

Helen has a tendency to depression, anxiety and problems such as anorexia in part because of her personality. She is someone who sets herself high standards and drives herself very hard. She has an overdeveloped sense of responsibility. She judges herself harshly and punishes herself for her own perceived failings. And she reacts badly to criticism from others.

She has some additional risk factors. She is, or rather was, a single mother. She has experienced several major losses: her older brother died in a farming accident when she was a teenager. Her last partner died by suicide. Also, her father was recently very ill. Her younger brother went missing for a year and her best friend felt betrayed by her.

All of this makes her vulnerable. So Rob hasn’t exactly caused it. But he has exacerbated it. And now he is using it against her.

Isn’t Rob also sick in the head?

Rob is also fictional. We only know what the writers have shown us. But again, we can make assumptions.

He certainly shows narcissistic tendencies. He cares a great deal about his own feelings, but little for those of others. He views the world as there to serve him. He constantly reminds Helen that she is Mrs Titchenor now, and that she must dress and act to please him. Henry must be “obedient”. The coming baby is “my son”. The house revolves around Rob . He is jealous and actively excludes those Helen is close to.

He also has a nasty temper, is untrustworthy and lacks morals. He hit the hunt saboteur and later lied about it. He cheated on his first wife with Helen, and lied to them both. There are suggestions he may have lied when he worked with Charlie. And there has been at least one occasion where he either raped Helen or was rough enough during sex to cause her bruising round the neck. She seems uneasy near him.

But these are not signs of mental illness. They are the tendencies of all bullies, cheats and those who get through life by using others. Rob has chosen Helen because she is vulnerable, and has resources that he wants – she has her own house, and will inherit half of the family farm business. And she can give him a child.

What about his mother? Is she mentally ill?

Aah, Ursula. She is a manipulator. She probably learned to behave like this as a small child herself because her own family was dysfunctional. Her relationship with Rob is deeply dysfunctional too. She wants to please him, and will go to any lengths to do so. She perceives Henry’s unhappiness as bad behaviour. She thinks sending him away to boarding school will help him. Her interest in Helen’s pregnancy, labour and other intimate matters such as Henry wetting his bed is prurient. I wonder whether she is a sex abuser. She gives me the creeps.

Why can’t Pat and Tony see through Rob and Ursula and why can’t they see their own daughter is so unhappy?

Because they are nice people. And they are deeply invested in Helen having made the right choice. They feel bad about not warming to Rob at the beginning. The truth for them is too awful to contemplate…at the moment.

What will happen to Helen?

Who knows? Only the writers. Perhaps her love for Henry will override her feelings for Rob, and she will confide in someone like Tom or Kirsty and they will help her to escape. Or perhaps she will be assessed by a mental health professional who will ask all the usual questions about things that are troubling her, and leave her enough space to express the doubts about Rob that we can already see lie just below the surface. Or perhaps she will continue to be terrorised by him until something even more awful occurs. This is what happens in real life. And even if they get away, women who have been abused like this may suffer from a form of post-traumatic stress disorder for the rest of their lives.

Why do I mind when people confuse mental illness with bad behaviour and say that people like Rob Titchenor are mentally ill?

Because badness is different from madness. You can have both. But they are not the same thing. And until people stop equating them, and the media stops using terms such as “paranoid schizophrenic” as a term of abuse, we have a very long way to go.

Of course we need to provide skilled intervention for those who abuse. They may have defects in their personalities (sometimes called narcissistic personality disorder, psychopathic personality disorder or sociopathic personality disorder) that cause them to lack empathy and feel compelled to hurt others. These terms are understandably helpful in forensic mental health services. But they should not be bandied about by the rest of us. Because this is skilled work. And also because, for people who have been diagnosed with a Borderline Personality Disorder, which has at long last been recognised as an extremely traumatic, treatable mental illness, being lumped together with people like Rob under the overall heading of personality disorders is distressing and adds to their stigma and alienation.

Time to Change is the national mental health anti-stigma campaign. Over the next five years, for which most of the funding is now secured, they will be tackling some of this harder, more intractable stuff with people who need more persuading. And people like me will be volunteering and writing stuff and speaking at events in support of their campaigns until we have achieved greater awareness, understanding and empathy for people like Helen.

The use of mental illness as an explanation for people who do abhorrent or otherwise inexplicable things is part of the stigma that those of us who experience mental illness face on a daily basis. Please try not to do it. Thank you.

PS: I’ve just noticed people on Twitter saying this storyline is affecting their mental health. Hmmm….It may trigger thoughts and feelings in those who have been abused and/or experience mental illness. But it won’t cause mental illness.

Anyway, people who don’t like it can always switch off. And watch Happy Valley maybe….